Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2063 FSPSA's found of which 29 had no frequency modifier field, FORCE FREQ MODIFIER to 0
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 38 7.975973 $386.8400 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 6 6 3.975039 $198.7500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 43 44 56.886494 $2844.3500 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 0.021916 $1.6500 $75.2900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 0.035614 $1.9800 $55.6200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 0.008219 $0.6200 $74.8300
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 2 0.252055 $12.8700 $51.0600
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 0.120548 $6.1500 $51.0300
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 32 33 11.580952 $1737.1800 $150.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.046575 $2.3800 $51.0800
SCREEN-T1023 SCREENING 3 3 0.509666 $25.4900 $50.0100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.142466 $7.2700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 3.406262 $173.8900 $51.0500
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Subtotal (Total Children Is Unduplicated) 103 145 84.967258 $5399.8300 $63.5500
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 40 44 15.852027 $792.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 6.285714 $157.1400 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 137 347 591.498113 $29575.0300 $50.0000
CONIP -CONIP CONSULT, PHONE 1 2 6.133334 $153.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 360.571428 $9014.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 40 42 300.080951 $15004.0700 $50.0000
INTR -T1013 INTERPRETER 12 17 37.143150 $1857.1600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 301 526 4441.466456 $44414.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 42.500001 $3036.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 7 50.285713 $3592.4200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 21 169.785712 $12129.5000 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 186 279 1495.721943 $747.8600 $0.5000
TRAV -TRAVS Travel by mile 287 617 116454.684652 $51822.3400 $0.4500
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Subtotal (Total Children Is Unduplicated) 420 1918 123972.009194 $172296.5800 $1.3900
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Total 2063 124056.976452 $177696.4100 $1.4300
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Number of Children (Unduplicated) With at Least One Authorization 427